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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION!� INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED All AP ICABLE Date: Permit Number: SCAN 1� 9 1 "`t_ Lurk i,� e Bui11211n� P�AP]iCdtiorpeI�t A'�'nsog4c,e � a� e Plann g and Development Services Buildi lig and Code Regulation Division 2300 Frginia Avenue, Fort Pierce FL 34982 Phon.: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential i✓ [kill'IT APPLICATION FOR: INPROVEMENT LOCAT(0 - " Q� o e I CHARLES WAY LOT 3 AND THAT PART OF SEC,9--? : �P 3 II � &a h•G�.& Ave • l � V`Ce . �!� � `� � b � 40 MPDAF: FROM SE COR OF S 1/2 OFS 1/2 OF't Address �_�� OF SE 1/4 RUN W ALG S LI OF SD 1/4 LI 258 F Legal I1/4 scription: TO POB,TH CONT-ON SAME LI 130 FT,TH N 145 II FT,TH E 130 FT,TH S 145 FT TO POB (1.19 AC) (OI 3564-2145: 3676-701) Prope:V Tax ID#: 31QI— RDq-0D6)3- 0D03 Lot No---- -- Site Piz i Name: Block No. Projec pp���� i Name: I�Ltm-n �Ukki11 � 1AIIJ r i Setba s Front Back: Right Side: Left Side: i DET tosJD Ingo IPTi©N to = I M. Cams-�&UeA10CA P4 UAC �l oYi `nrh In/�l ov, W s� Cara vL A�ozl' D 4a CONSTR++ CTIO 1'N�f�}RMATi�N: Iti na work to be pertormed uncler t Is •permit— c eck all that app y: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Electric _ Plumbing _ Sprinklers Generator _ Roof Pitch Total S' Ft of Construction: ��� Sq:=Ft: of FirstEloor•: Cost o Construction: $ 1 Utilities:;:,- r $ewer;;;.•,'S,e`pt c, , Building Height: Nam Name: P ftLv DlP�tn 4atC CompanA& c lrr Addr�03// i : P/Lt State: /_L City: Address:' zipC :41e'-, , 3 �/�i: 8.,'_ :.Fax;' City:i��f-� State: PIQ°• .. r 5 j Y Zip Code: 3��'j �% Fax: E-Ma'i [gym c lce_A;40VIt-A. nx_� Phone No Fill in E-Mail fee simple Title Holder on next page ( if different.:, from the Owner listed above) State or County Licensee—[;/�ZL/�3 If value f construction is 2500:grmore, a RECORDED Notice of Commencement is required. 6- IE. T 0701-�.E DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: _ Name:, Address: Address: I.I City: Zip: Phonei State: City: State: I'I Phone: FEE SIMPLE TITLEHOLDER: Name: Address: _ Not Applicable BONDING COMPANY: Not Applicable Name: Address: City: City: Zip: Phone: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures; swimming pools, fences; walls, signs, screen rooms and accessory uses to another non-residential use WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording your Notice of Commencement. Signature of Ow r/ Lessee/Contractor as Agent f wner Signature of Contractor/Li ns older STATE OF FLORIDA COUNTY OF - �7 The forgoing instrumoX was acknowledged before me this day of 201f-by Name of person making statement. Personally Known OR Produced Identification Type of Identificatio t Vivienne Finletter Produced NOTARYPUBLIC g STATE OF FLORID) Comm# GG133001 SINCE t ► Expires 8/11 /2021 (Signi#6a of Notary Public- State of Florida ) Commission No. Cq1t le (Seal) REVIEWS I FRONT COUNTER DATE RECEIVED DATE COMPLETED ZONING REVIEW STATE OF FLORID�1 , COUNTY OF - The forgoing instr ent was acknowledged before me this day of 20d_ by U:IA Lbk M A Name of person maki Personally Known OR Produced Identification Type of Identification Produced - re of Notary Public - Commission No. IE SUPERVISOR PLAN VEGET REVIEW REVIEW REVII i�"I.J HnIA INGRAM � I _ a Ada Notary Public telly Comrti` atonidk Dec: A9--- of Florida )